Saturday, July 02, 2022

From Sandshoes to Tennis Shoes to Hi Fashion: A brief history

( Charles Goodyear Image via wikipedia )

In 1832, Wait Webster patented a process to cement rubber soles to the uppers of shoes and boots. At first the shoes were flimsy and came apart easily. After 1862, when Charles Goodyear developed vulcanization more robust rubber products became available. Vulcanization involved an industrial process where a mixture of sulphur and tree sap gum were heated producing a stable and pliable material. In the UK, the New Liverpool Rubber Company developed a light shoe which combined a cotton canvas top to a rubber sole. These were called sandshoes and became popular with urban working class people keen to enjoy a day at the seaside and conveyed there by the new railway systems. Sand shoes frequently burst but because they were cheap were often worn for one trip only. To reinforce the join of upper to sole companies started to use a thinner rubber band wrapped around the shoe trapping supporting the join between canvas and rubber. The new style shoes were called a plimsoll after the white plimsoll lines on ships which was introduced in 1876. Plimsolls wore well, kept the feet cool in the summer and dried quickly after a paddle in the sea. The canvas could be painted chalk white which give the outward impression the shoes were croquet shoes and made from kangaroo skin. Quality croquet shoes were worn by the wealthier classes and were the first sport shoes to cross over to fashion. Victorian promenaders, keen to look their best in the Madras jackets and flannels, started to wear white plimsolls.

( Dorothea Douglass Image via wikipedia)

The plimsoll marked the beginning of the modern sport shoe and when the middle classes became more interested in leisure activities and sports, the plimsoll evolved into many other forms. When cinder and grass tennis courts were in vogue rubber soled plimsolls were used extensively. Sole patterns were added and patented to add grip and court adhesion and plimsolls did not destroy lawn surfaces. Rubber soled shoes helped soften the landing of a long jumper as well as being eminently suited for yachting and first appeared at the Paris Olympics in 1924. Gradually plimsolls were further developed to meet requirements of both major and minor popular sports. A simple rubber strip was added to the toe box to stop the big toe nail appearing through the canvas. This also stopped the weakest part of the upper from abrasion in those sports where the foot was dragged for balance. The hockey boot incorporated moulded studs into the rubber sole and the cycle shoe was easily adapted to speed running by the application of metal spikes to the area of the sole under the ball of the foot. Spikes gradually grew longer and longer until they were approximately two inches long. These could be adjusted to suit the ground conditions. When foam rubber was invented in-socks were applied to the shoes adding to the comfort. As soon as the Armed Services began using them the shoes were ordered in the tens of thousands and all coloured to suit the army, navy and airforce. Service plimsolls became a popular demob souvenir as well as becoming compulsory wear for children at school as physical exercise (gym) became an accepted part of the formal public school curriculum.

( Adrian Quist Image via

At the end of the thirties Australian professional tennis player Adrian Quist after a visit to the US and spending time sailing realized the benefits of better traction on the sole of shoes and convinced Dunlop Australia to make Dunlop Volleys.

( DV's Image via )

For the next three decades (i.e. 50s to the 70s), they became synonymous with Australian sport. A household name during the nation's sporting 'Golden Era', post war they became associated with many of the sporting legends of the time Adrian Quist, Lew Hoad, Ken Rosewall, Tony Roche, John Newcombe, Evonne Goolagong, Margaret Court, Peter Thomson, Greg Norman and more lately Mark Philippoussis. In the days before hard courts the Dunlop Volley was perfect for grass court competition. Sole patterns were changing and. the vogue for circles and squares in the 60s were replaced by trendy herringbone patterns, in the seventies.

( Shoes as advertised in Spalding’s Base Ball Guide of 1883 Image via )

In the US at the end of the 19th century the US Rubber Company produced rubber soled shoes similar to those in the UK. In 1907 the Spalding Company produced shoes specifically for the game of basketball. Later in 1916 when the US Rubber Company and Goodyear merged they produced rubber soled shoes with canvas uppers they were called sneakers. Many believe the word "sneaker" came from an advertising agent called Henry Nelson McKinney, who worked for N. W. Ayer & Son in 1917 and was struck by soundless movement when walking in rubber soled shoes. However, sneaker had been used as early as 1887, when it appeared in the Boston Journal of Education "the name (sic sneaker) boys give to tennis shoes". Indeed, cheap rubber shoes were worn by thieves referred to sneak(er) thieves.

(Converse 1917 Image via pinterest)

High basketball boots became available in 1917 made by Converse and known as the Converse All Stars. These proved a popular choice both on court and off. In 1923 Chuck Taylor signature Converse were introduced with an ankle patch and these were called Chucks. Despite niche interest at first the market for trainers was small but after World War I, the Western pre-occupation with physical culture the U.S. market for sneakers grew steadily as young boys lined up to buy sneakers endorsed by football player Jim Thorpe and Converse All Stars endorsed by basketball player Chuck Taylor. The first major endorsement of a sport's shoe by a sporting personality was Chuck Taylor and Converse All Stars. Taylor was a basketball player with Buffalo Germans and Akron Firestones. The campaign proved so successful the shoes became known as "chucks", and Converse All Stars still remain a popular brand, today.

( vintage keds advert Image via )

According to Steele, the first popular sneaker was introduced in the United States in 1917 under the name of Keds and made by the National India Rubber Company.Some suggest the K stood for kids and the term was rhyming slang for ped(s), the Latin for foot. However the name was already registered for another product, so the "P" was traded for a "K". At first Keds were tennis shoes available with brown canvas tops with black rubber soles. During the wars servicemen were issued with canvas topped rubbers for exercise and most took them home as souvenirs. Soon their older kids were wearing them to dance to quick tempo dance music of Swing and Jive. In the 50s manmade fibres became available and the plimsoll and sneaker merged to become a hybrid called the trainer shoe. The development of synthetics materials had a profound effect on the sports shoe. Hard, durable nylon soles provided lightweight, flexible and capable of supporting studs for football and spikes for athletics. Cellular foams increased the fit and comfort. The trainer had a two colour finish, low heel, rippled sole without an instep. It was used by the athletes as warm up and training footwear and first made its appearance at the Melbourne Olympics, 1956. The use of contrasting colours for reinforcement areas gave the training shoe its distinctive characteristics. Since then the trainer has became a fashion item worn by all in society and certainly not restricted to sports’ persons.

(Marilyn Monroe Image via pinterest)

Throughout the Western world during the 1950s sneakers became associated with the merging teenage leisure market. They were cheap, hardwearing and suitable for sport and leisure activities such as dancing. Worn by high school students around the world they soon became the icons of youthful rebellion. Whilst their older sisters wore stilettos, the young fry were doing it in canvas topped shoes. The appeal of American sneakers was confirmed when James Dean and Elvis Presley were photographed wearing low cut canvas topped rubber soled shoes. Keds for girls and chucks for boys.

Interesting Information
Kippen C (2019) A brief history of Athletic Shoes foot talk blog
Kippen C (2019) A brief history of blue chip trainers foot talk blog
Kippen C (2022) A Call for a Dunlop Volley Day (DVD) foot talk blog
Kippen C (2022) Anyone for tennis? : Not with these painful blisters foot talk blog
Kippen C (2020) A potted history of designer trainers foot talk blog
Kippen C (2018) Australia's evergreen sneakers: DVs and KT26s foot talk blog
Kippen C (2019) DVs: Green and Gold old timers foot talk blog
Kippen C (2019) Evergreen trainers: What's the story...? foot talk blog
Kippen C (2018) Fred Perry 1934 Tennis Shoe foot talk blog
Kippen C (2019) History of trainers: Dunlop Volleys from sport to fashion foot talk blog
Kippen C (2019) Plimsolls: The Godfather of Sole foot talk blog
Kippen C (2022) The couch potato's guide to tennis bum, blisters, and bunions foot talk blog

Reviewed 02/07/2022

Thursday, June 30, 2022

The couch potato's guide to tennis bum, blisters, and bunions

( mode tennis Image via pinterest )

Tennis Bum is not so much a medical condition as a mental state of mind when the tennis season is on. Midst a pandemic, millions of couch potatoes sit glued to the box with little or no movement thereafter. A numb bum is usually the result caused by sitting too long. Fortunately I am of a certain age where the impetus to play the game, much as I love to watch it, has become an avenue of pleasure closed off. But I cannot say the same for the countless throngs of couch potatoes who inspired by what they see on the telly decide to play tennis with the inevitable outcome of getting blisters. Painful blisters can and do bring even the most seasoned professionals to their knees, so they are unlikely to spare to amateur.

( Blister treatment Image via pinterest )

One of the most common problems people experience when the tennis season starts and that is troublesome blisters. To give them their Sunday best description blisters are a dilation of an existing space within the epidermis, (that's the outside layer of the skin), which fills, with exudation i.e. excess tissue fluid or blood. Superficial blisters or vesicles are the most common to arise and measure app. 0.5cm in diameter. These are caused by friction when the skin temporarily rubs against another rough surface. Dynamic Friction causes damage to the skin cells and fluid gathers to help protect the lower tissues. Overlying pressure cannot pass through the fluid which offer temporary protection. The usual symptom is a burning pain. If ignored (i.e. the player plays on), the blister can burst and infection a likely outcome. Hours and hours of play drive the skin separation deeper and sometimes a bursa (fluid filled sac) or bursitis (inflamed bursa) will arise.

(Video Courtesy: Rebecca Rushton Youtube Channel)

A favourite old time treatment for blisters was a cabbage poultice. Placed carefully in the shoe beside the site of the blister the cabbage poultice acts as a physical barrier preventing further sheers between opposing surfaces. This is the first principle of treating a blister but I cannot see either Novak Djokovic or Ashleigh Barty wearing a cabbage poultice. Can you?

( Cabbage poultice Image via pinteres )

A common temptation is to burst the blister. Not a good idea and best left with the skin surface intact. To encourage reabsorption of tissue fluid and reduce shear between surfaces the intact blister should be covered with stretch strapping. This maybe enough but if painful symptoms persist then surgical lancing is best done by a health care professional.

(Video Courtesy: Blister Prevention Youtube Channel)

A common ailment exacerbated by friction from shoes is bunions (bursitis). A very old remedy for mild bursitis was a cow dung rub. More recently nightly massage using patchouli and lavender oil, or chamomile or geranium ointment has been substituted. However, comforting as this might be, There is no scientific evidence to support this approach alone. Lay people often confuse bunions with a bony misalignment which occurs as a result of Hallux Abducto Valgus (HAV) and renders the head of the first metatarasal prominant on the instep. The protruding bone may be protected by a adventitious bursa which can become inflammed (bursitis). HAV results from rearfoot instability and describes a triplane subluxation of the forefoot common to most bi-peds which remain asymptomatic for the majority. However arrow shaped feet present a challenge and tennis players should choose good fitting footwear to avoid damage caused by sheer.

(Bunion Image via JAS Reality )

HAV and painful bunions interfere with the main fulcrum mechanicsm of the foot ie. First Metatarsal Planangeal Joint and stop peak sporting prowess. Many professional players plagued with sore feet undergo surgical procedures to alleviate their discomfort. Top pressionals have lucrative shoe contracts which ensures their footwear are custom fitted whereas lesser mortals requirew to be very careful when buying their tennis shoes.

(Best tennis shoes for bunions Image via pinterest )

So if you want to play the odd game of tennis you might like to take a few sensible precautions. First thing is to get a pair of tennis shoes that fit the feet comfortably. The range of tennis footgear is extensive and these have been designed to cope with the stresses of the game, ordinary trainers may seem similar but are definitely not. Slipping on the old shoes for a few sets is bound to aggravate the skin.

(Anatomy of a tennos shoe Image via Paperblog )

Some people advocate greasing the skin which gives lubrication to cut down friction but this can be messy. Others prefer to use surgical spirit to toughen the skin. This may appear logical but is not recommend because it dries out the skin and makes it less able to naturally deal with friction. According to Rebecca Rushton, acknowledged expert in blister care, wearing two pairs of socks (inner and outer) will reduce the effect of heat generating dynamic friction on the skin surface. Instead movement occurs between the sock layers and not on the skin surface. Any skin lesions should be covered with a strapping such as a band aid and a light talc skin and shoe will further reduce friction areas. Always take time to warm up before a session by stretching and warm down after a game. This prevents stiffness and reduces the risk of injury. Aches and pains should not be ignored and persistent pain may need professional care. Follow these simple steps and keep up the practice and I may see you on the telly, next year.


(Cinderells's slipper Image via Digital Spy )

There are more than 150 operations for hallux valgus. One critic of forefoot surgery was Hans Rudolph Mayer, a Swiss medic, he believed many procedures had been designed to alter the female foot not for functional reasons but instead for cosmetic reasons to fit typical female shaped shoes. He called this the Cinderella Principle. In Cinderella (Walt Disney) the glass slipper was broken by the grotesque ugly sister. However in the original version of the fairytale, the wicked mother cuts the daughters foot in order to fit the shoe. When ladies complain of sore feet, they usually have a bunion or hallux valgus, or both.

Please note
The above does not constitue actual medical advice and has been posted to inform only. If you suffer from sore feet then please consult your own foot physician.

More Information
Jonathon (2022) The Best Men’s Tennis Shoes For 2022
Kippen C (2022) Strokes, Silent Strokes and transient ischemic attacks : The benefits of regular exercise and diet foot talk blog
Leonard 2021 Best tennis shoes for Bunions
Rushton R 2021 Blister Prevention

Reviewed 30/06/2022

Wednesday, June 29, 2022

A Call for a Dunlop Volley Day (DVD)

It may surprise you but many CBD commuters travel to and fro work wearing trainers. Concerns for foot health among a generation of power dressers has prompted a young Australian shoe designer to develop a prototype heeled shoe which converts to a lower "sensible" heel so promenaders need not lose the edge of fashion as they step out to walk to work.

There are three competing theories to explain the rise in popularity of sporty shoes in older populations. The first relates to a transport strike in NY when the city ground to a halt and people had to walk to work. They chose to wear their leisure shoes. Designers saw a window of opportunity and the fashionista had to be seen in designer trainers. A similar renaissance has been seen in Wellingtons thanks mainly to Hollywood glitterati living the English Country Life.

The second theory relates to Jane Fonda and the fashion fad for aerobics. When she started to produce her home exercise videos set to contemporary music the "30's something" had to have the gear as well as the exercise experience.

Finally and probably the most likely answer is as the 60s generation (The Bulge post war kids) have aged they have taken their habits (good and bad) with them. Keds and Chucks belong to the beat generation and they intend to grow old disgracefully wearing their canvas topped rubber soled shoes (and /or equivalent).

I have always barracked for a special day in Australia to commemorate the grandfather of the modern trainer, Adrian Quist. He was a champion tennis player before World War II and realized that ground traction was the secret to better foot control after seeing boaties negotiated wet decks. He convinced the Dunlop Rubber company to include tread patterns on their tennis shoes and the Dunlop Volley was invented.

For thirty years, DVs ruled the scene until the 70s boom brought in the designer trainer.

(Video Courtesy: British Pathé by Youtube Channel)

Reviewed 16/06/2022

Tuesday, June 28, 2022

Anyone for tennis? : Not with these painful blisters

Anyone for tennis? The smell of Wimbledon is in the air with the promise of strawberries and cream and hot days (well maybe) on Centre Court. One phenomenon about big televised events like Wimbledon is couch potatoes find their plimsolls and get themselves their rackets and start to recapture form on the asphalt. Sadly many get painful blisters which quickly ground them back onto the couch for another year. Well worth it then, to read An Introduction to Shear and Blister Formation by John Vonhof, author of Happy Feet.

Friday, June 24, 2022

Falls prevention in the elderly: What shoe features help or hinder falls prevention ?

( Postural Sway Image via Research Gait )

Although footwear has been linked to falls in older people, it remains unclear as to which shoe features are more beneficial or detrimental to balance in older people. When a systematic investigate to discover how footwear features affect balance and stepping in older people was undertaken. The subjects were tested for postural sway, maximal balance range, coordinated stability and choice-stepping reaction time in a standard shoe and seven other shoes that differed from the standard shoe in one feature only, namely: elevated heel (4.5 cm), soft sole, hard sole, flared sole, bevelled heel, high heel-collar and tread sole.

( walking shoe for seniors Image via WalkJogRun )

Repeated-measures ANOVA with simple contrasts revealed significantly increased sway in the elevated heel versus the standard shoe condition (p value less than 0.05). A footwear performance index based on the sum of z-scores across three tests (sway, coordinated stability and choice-stepping reaction time) normalized to the standard condition indicated that the elevated heel was most detrimental to balance (p value less than 0.05) whereas a high heel-collar and a hard sole showed trends towards being beneficial.

( Reviewing research Image via )

The researchers concluded an elevated heel of only 4.5 cm height significantly impaired balance in older people but acknowledged the potential benefits of wearing shoes with a hard sole or a high heel-collar on balance in older people warranted further research in ambulatory tasks. Some characteristics of footwear influence balance in older people but the relationship between footwear and falls is still unclear.

(Geriatic Falls Image via Cleveland Clic)

Another study undertaken by the same group was to determine the relationships between footwear characteristics and the risk of indoor and outdoor falls in older people. Footwear characteristics (shoe type, heel height, heel counter height, heel width, critical tipping angle, method of fixation, heel counter stiffness, sole rigidity and flexion point, tread pattern and sole hardness) were assessed in 176 people (56 men and 120 women) aged 62-96 (mean age 80.1, SD 6.4) residing in a retirement village. Falls were recorded over a 12-month follow-up period and comparisons made between fallers and non-fallers. Analysis of the results revealed 50 participants (29%) fell indoors and 36 (21%) fell outdoors. After controlling for age, gender, demographic characteristics, medication use, physiological falls risk factors and foot problems, those who fell indoors were more likely to go barefoot or wear socks inside the home (OR = 13.74; 95% CI 3.88-48.61, p value less than 0.01). However, there were no significant differences in indoor or outdoor footwear characteristics between fallers and non-fallers. Five indoor fallers (10%) and three outdoor fallers (8%) stated that their shoes contributed to their fall.

(Well worn Slippers Image via )

The researchers concluded footwear characteristics were not significantly associated with falls either inside or outside the home. Risk of falling indoors was however associated with going barefoot or wearing socks. Older people at risk of falling should therefore be advised to wear shoes indoors where possible. In a previous study of footwear and hip fractures, older people who suffered a trip-related fracture were more likely to be wearing shoes without any method of fixation (ie: laces, buckles, etc).

Interesting reading
Hemler SL, Pliner EM, Redfern MS, Haight JM, & Beschorner KE (2022) Effects of natural shoe wear on traction performance: a longitudinal study Footwear Science Volume 14, 2022 - Issue 1

Menant JC et al 2008 Effects of footwear features on balance and stepping in older people Gerontology ;54(1):18-23.
Menant JC et al 2008 Effects of shoe characteristics on dynamic stability when walking on even and uneven surfaces in young and older people Arch Phys Med Rehabil. Oct;89(10):1970-6.
Menant JC et al 2009 Effects of walking surfaces and footwear on temporo-spatial gait parameters in young and older people Gait Posture ;29(3):392-7.
Menant JC et al 2009 Optimizing footwear for older people at risk of falls J Rehabil Res Dev;45(8):1167-81.

Reviewed 12/04/2022

Wednesday, June 15, 2022

Merry Quip

( Image via King )

Monday, June 13, 2022

Chiropody Felt: A brief history

One of the most enduring footcare accessories to be found in your friendly pharmacy is Chiropody Felt. Felt is a fabric made from wool but unlike weaving and knitting there is no yarn involved. To make felt you need wool fleece, water and agitation. The fibres on the wool have small scales on the outside surface. When the wool is watered down the scales open up. When the fibres are rubbed together, the opened scales close and get interlocked. The wool fibers are made up of a protein called keratin. The keratin in the fibers becomes chemically bound to the protein of the other fibres thereby resulting in a permanent bond between them, making the felting process irreversible.

Originally Chiropody felt was made from quality merino wool and consisted of thousands of fibres compressed one on top of each other with air trapped in the structure. It is available in compressed and semi-compressed forms and is easy to cut and shape with scissors.The impacted fibres offer resistance to compression where the foot makes ground contact or toes rub against each other. Cavities cut in the material help reduce shear and peak pressures, which can relieve pain and discomfort. The trapped air heats up and acts as insulation to the surrounding tissues, and the constant temperature can have a direct sedative action to superficial nerve endings.

In late Victorian Times adhesive backing made from soap plasters was introduced but proved somewhat messy in use. Later the adhesive industry introduced new and improved rubber adhesives which soon became popular, especially when Zinc Oxide was added to prevent rashes. Over the last half century hypo-allergic adhesives have replaced zinc oxide rubber adhesives and these prevent allergies and pseudo-allergies when chiropody felt is used regularly next to the skin. Adhesive backed chiropody felt traps microscopic drops of water in the keratin layers of the skin, hydrating them and making them softer and in the case of corns, less painful. These are temporary functions but all add to the comfort of Chiropody Felt.

No one is quite sure when felt was first discovered but it is considered to be one of the oldest textile forms and thought to have originated in Asia about 5000 years old. Archaeological evidence indicates from very early on people had discovered the tendency for fibres to mat together when warm and damp long before they learned to spin or weave. It is believed the nomadic people of Central Asia were the first to learn the techniques for making felt. Caps of thick solid felt from the early Bronze Age are preserved at the National Museum in Copenhagen. These date back some 3500 years and were found in the pre-historic burial mounds of Jutland and North Slesvig. The oldest archaeological finds containing evidence of the use of felt are in Turkey. Wall paintings that date from 6500 to 3000 B.C. have been found which have the motif of felt appliqué. At Pazyryk in Southern Siberia archeological evidence of felt was found inside a frozen tomb of a nomadic tribal chief that dates from the fifth century B.C. The evidence from this find shows a highly developed technology of felt making. (These felts are in the Hermitage Museum in St. Petersburg, Russia).

The Romans and Greeks both used felt and the Roman soldiers were equipped with felt breastplates (for protection from arrows), tunics, boots and socks. The earliest felt found in Scandinavia dates back to the Iron Age. Felt sheets believed to be from about 500 A.D. were found covering a body in a tomb in Hordaland, Norway. Felt was used for many things including hats, wall coverings, blankets and boots.

Felt boots can be traced to Siberia and was called the Valenki. Archaeological finds include dainty low riding boots of a Scythian woman of high rank which also contained a pair of felt socks of the same cut and sewn from two pieces of thin white felt. The remains of travelers caught in ice glaciers also support felting in shoes was used to keep the feet warm. Not only was felt used for clothing but also for saddles, curtains, rugs, coffin coverings, bottle cases, mattresses, shelter and for ceremonial purposes as well. In pre-history properties of felt, were greatly appreciated and exploited with felt relics found dating back to 1500-1000 B.C. in Mongolia, Scandinavia, Germany, Turkey and Siberia. Excavations at Antinoe in Upper Egypt revealed clothing items of wool felt in graves of the Coptic period. These goods may have reached the Nile valley through trade from Persia.

Ancient Chinese historical records refer to felt as early as 2300 B.C. China's warriors equipped themselves with shields, clothes, and hats made of felt, for protection; they also used felt boats. At public functions, the Chinese emperor was carried into the presence of his subjects sitting on a large felt mat.

By the Middle Ages many legends existed as to the origins of felting including the claim Noah discovered it. According to the legend when he built an ark he covered the floor with sheep's wool and loaded it with his family, their household belongings, and livestock for food. However, the weather suddenly turned bad and rainwater came pouring in. Inside were many people and animals moving about; the heat produced from this was almost overwhelming. The water and heat combined with repeated trampling on the wool made become a flat sheet of felt. Another variation on the theological theme described a barefoot holy man walking through the desert, leading his camel. With the mid-day sun the sand became too hot and he could no longer walk. Almost by divine guidance he suddenly tore off clumps of the camel's hair and wrapped them around his feet. Finally sunset came and the heat subsided. Removing the clumps of camel hair, he noticed that the camel hair on the soles of his feet had become flat and solid. His sweat had added moisture, the sand had added heat, and the action of walking on the camel hair had entangled it, turning it into flat sheets of felt.

When a Pope during the Middle Ages was troubled with sore feet, he decided to use some animal wool to pad his shoes. Bliss resulted and felt “tootsie rolls” were given the Papal Pedal Seal of Approval.

More Information
Kippen C 2022 Physical Therapy: Principles of Pad Making Foot Talk blog
Kippen C 2022 Physical Therapy: Introduction to foot padding and taping 101 Foot Talk blog

Reviewed 13/06/2022

Physical Therapy: Introduction to foot padding and taping 101

Making use of padding and tapping has become a specialised field of podiatry and other physical therapy disciplines, the origins of which, are based on empirical clinical practice. As technologies have developed and more materials become available, padding and taping is now quite sophisticated. Ironically advancement in material science has not always met with clinical research. Hence the justification and claims for many traditional padding prescriptions remain unchallenged. Practitioners continue to rely on anecdotal evidence to support the continued use of their favourite prescriptions. A proficient pad maker requires a thorough knowledge of the individual case to be managed as well as a competent understanding of material science, if they wish to understand the effects of their treatments. Clinical padding appears to alleviate minor symptoms and can achieve measurable improvement in the quality of life of the patient. The principles of foot padding and taping and instruction on how to make the prescriptions are briefly given below. With supervised practice you should be able to prescribe, make and fit a range of commonly used clinical padding and taping. The same clinical skills can be transferred to the prescription of foot orthoses.

Mechanical Therapy
Mechanical therapy describes the application of temporary leverage to the foot, either by adhesive or replaceable methods. Often referred to as padding and tapping this form of physical therapy is used as a first line or chairside approach to clinical management. Mechanical therapy may also be incorporated into other modalities such as foot orthoses.

Clinical materials are divided into four main groups:
• Padding Materials,
• Strapping or taping,
• Bandages, and
• Dressings.

Clinical Padding Materials
Padding materials have certain functions which are related to their method of construction. Adhesive backed materials act by binding down the skin temporarily, reducing dynamic friction across the skin surface, as well as trapping water microscopically and hydrating the skin. Increased presence of water appears to help skin cell desquamation. Historically padding materials were available in natural merino wool but today most are made with synthetic materials

Padding can be classified as:
• non-cellular, e.g. chiropodists felt: and
• cellular foams, such as latex rubber foam.

a) Non-Cellular Material

White Wool Felt

For economy, chiropody felt is made of 30% synthetic fibres trapped in 70% wool. The thickness of the padding compacts relatively quickly and leaves a harden mass. White felt is available as semi compressed and soft densities in various thicknesses and with hypo-allergenic adhesive backing. Because the material offers resistance these are ideal to increase surface contact of the foot and are used to deflect pressure from high pressure points. The materials are easy to scissors bevel and can be applied to any skin surface. Fibres of felt absorb fluids very easily but will not express it, hence, it is not advisable to get felt padding, wet. Compression, friction and wear cause the material to lose resilience and eventually degrade. Felt padding has an active life of approximately between three to four weeks wear before it needs be replaced. While felt is exceedingly useful for padding it has certain disadvantages. Felt pads soak up water and takes some time to express it completely. Felt materials are expensive. and regular bathing or showering accelerate wear and tear. For this reason alone felt padding can only be temporary, but no less efficient. The most popular white felt is semi compressed wool felt 5-7mm. i.e. Semi Compressed Felt (Hapla).

Adhesive Backed Fabrics.

Woven fabrics are usually made from cotton warp and weft threads. These are covered with adhesives and provide a versatile skin cover. The top side of the material can be raised by a linting process which provides a soft fleecy surface e.g. Fleecy Web (Hapla). The warp and weft threads are woven in such a way as to include either one way stretch or two way stretch. This makes fabrics very useful for binding down the skin and providing protection over high friction areas of the foot. Adhesive backed fabrics include Fleecy Web (Hapla) and Moleskin (Hapla) . The latter is more tightly woven with a shorter and finer linting. Both materials are used as anti-friction covers for vulnerable areas of the skin.

b) Cellular Material

There are two types of foam i.e. open and closed cell.

Open Cell Foams

Open cell foam has linked pockets of interconnected cells, incorporating air. The material compresses easily and recalls almost to its original shape. Latex foam is produced from rubber sap then beaten into a foam. The material is stabilised before being sprayed onto fabrics at given thicknesses, then left to vulcanised. Open cell foam, such as latex foam, are made up of a honeycomb of interconnecting cells which allow air can pass through them freely. On weight bearing air is expressed out as the material collapses with regain occurring as the air flow back. This provides useful cushioning by absorption and can be used over tender areas of the foot exposed to shearing stress. Grey latex foam, or moleskin (same material with a linted surface) are used in podiatry. Tubifoam (Seton) is a hollow cylindrical shaped length of open cell foam with an inner covering of gauze. These are used to protect toes. Open cell foams provide insulation to the skin as air heats up due to the high temperatures in the shoe. The skin is insulated which may keep the feet feeling warm. The life span of cellular materials remains short because the materials have a poor elastic memory and degrade easily. Open cell foam prescriptions will maintain their properties for approximately three weeks.

Closed cell foams

Closed Cell Foams consist of a series of self-contained cells filled with inert gas. The material resists compression as pressure and friction cannot pass through the gas. These materials are generally not available with adhesive backings, but instead are commonly used in the manufacture of accommodative foot orthoses.

Foam and Felt Combinations. The combined properties of felt to distribute pressure and cushioning by absorption can be found in foam and felt sandwich materials. Available commercially these tend to be a little more expensive and it remains debatable as to how much better these are compared to foam or felt padding alone.

Viscoelastic Padding

Composites made from synthetic polymers have revolutionised the industry. Some 'skins' are available for padding and used to protect sensitive skin areas from shearing stress. The physical properties of the materials last longer than non viscoelastic alternatives and digital devices are often trapped within a knitted fabric. Other viscoelastic polymers are commonly used in the manufacture of foot orthoses.

Strapping and Taping Materials

Medical Grade Adhesive Tapes.

Self-adhesive or pressure sensitive plasters are manufactured by spreading the pressure sensitive mass onto various materials. Self-adhesive types are made from a mixture of a cohesive substance such as rubber or a synthetic substitute and tackifiers like colophony and/or other resins, to provide the adhesive qualities. Plasticisers such as olive oil or lanolin are used to make the materials pliable with added fillers such as powdered orris root to give the material more body. Most plasters are available in hypoallergenic form to prevent skin irritation. The pressure sensitive mass may be spread on a variety of surfaces including:

o plain holland (zinc oxide rigid strapping) This is good for binding the skin;
o single and two way stretch fabrics This increases the binding properties of the strapping without restricting movement and hence can be used over joints e.g. stockinette, and fleecy web;
o synthetic surfaces

Most of the medical grade lightweight hypoallergic strapping contains tiny holes to encourage air exchange whilst acting as a physical barrier to the skin.

Taping (Strapping) is applied to the foot as a means of support. If it includes padding this prevents skin slippage and the combined physical properties of the material may provide a variety of uses to the therapist. Medical grade adhesive tapes are available in different widths and colours and the selection is determined by the part of the foot to be strapped and the therapeutic purpose.

Bandages and Dressings

These vary with material and the type of weave used in their manufacture. Most are open weave often with combination of synthetic and natural polymers. Bandages may be used for a variety of reasons. Most are applied under slight tension and therefore they must resist stretch. Bandages are applied for compression after injury to reduce the amount of swelling or to hold dressings in place. Knitted tubular bandages are used as toe covers to retain digital prescriptions.

Sterile Dressing such as Melolin (Smith+Nephew) and Melolite (Smith+Nephew) are industrially prepacked and available to cover small open wounds. Some dressings are medicated with antiseptics.

More Information
Kippen C 2022 Chiropody Felt: A brief history Foot Talk blog
Kippen C 2022 Physical Therapy: Principles of Pad Making Foot Talk blog

Reviewed 13/06/2022

Physical Therapy: Principles of Pad Making

It makes good sense before embarking on a complex padding prescription to first think through what you hope to achieve with your clinical management. Successful prescriptions are based on the practitioner knowing the following:

What are the problems?
What are the most likely causes?
What properties does the materials need ?
How best to apply to the skin ?

Clinicians follow a common logic to address clinical problems. A simple four-point logic for padding is Construction, Retention, Application, and Prescription (or CRAP). The simple acronym helps the novice recall the important principles


Padding materials have been developed to incorporate many features which are useful to the clinician. A comprehensive knowledge of what the materials are capable of, is the key to optimal success. Manual dexterity coupled with an elementary knowledge of the foot will ensure pad prescriptions have best effect. Cutting for economy and bevelling, help mould padding to the skin. This makes strapping easier as well as reducing costs.

To prevent the edges of strapping from curling the ends should be cut and rounded. Anchor straps are be applied to the most proximal aspect of plantar padding, with proximal arch strappings always superior to the anchor strap. This prevents unwanted movement when the feet are weight-bearing. Strapping tightly around the digits should be avoided. Use Tube gauze (Seaton) as an alternative for toe padding. Selection of replaceable bands should first involve a thorough assessment of the patient's circulation, flexibility, and dexterity. Patients should be informed of care and maintenance and capable of accepting these instructions. When necessary written instruction should accompany padding.

Most padding is applied to the skin under tension. Prescriptions need to be stuck on the correct area of the foot and remain there, during walking. The choice of suitable strapping or other means is critical. Previous adhesive marks should be removed from the skin with the use of solvents. Strapping should not interfere with foot function, except where expressly used for that purpose. Covering the nail or open lesions with adhesive should always be avoided.

To choose an appropriate prescription requires a good working diagnosis. It is not always possible to understand the origins of clinical problems, especially where there are multi variables involved. However, the clinician will develop a working diagnosis in their attempt to clinically problem solve. This means instigating temporary episodes of treatment which should have identified short term goals. Clinical padding and taping can be useful in short term goals and modified in light of evidence-based outcomes.

In summary adhesive padding offers the following advantages:

• they bind the skin down;
• increase surface contact area of the foot and reduce peak pressure;
• provide protection to sensitive areas; and
• offer a suitable medium to retain medication closer to the skin.

Choice of material, type and thickness depend on several factors including the patient's weight, occupation, and shoe type. Age, mobility, dexterity, skin types and sensitivities are also all important factors.

Prescription Logic

Before making a pad, it is important to establish the following:

Are there any contra-indications to the use of adhesives?
Allergies to rubber compounds are common but people may also be allergic to hypoallergic tape. It is good practice to make enquiry before cutting prescriptions.

Is the person able to wear, care and maintain the prescribed padding?
No point is applying a prescription, unless the client is able to look after it or willing to wear the device. What is the purpose of the pad in association with the dynamic foot?
Consider the segment of the gait cycle which would give the greatest mechanical advantage to the prescription. This way you can define the prescription in anatomical terms.

Do you require to bind the skin down?
Sometimes a contributory factor is the amount of shearing stresses passing over the lesion. Binding the skin tighter would reduce the adverse effects of dynamic friction.

Are you wanting to cushion the area or to deflect peak pressures from high pressure area?
This has implications for the type of material used and how the pad is retained to the foot or shoe.
Do you want the prescription to include a wing or cut out section?
Or house a medication in the form of a thick buffer type ointment

Advantages and Disadvantages of Padding

For Adhesive Padding
• Can be positioned accurately to the foot
• Moulds closely to the affected parts
• Taping helps prevent unwanted movement.
• Adhesive promotes local hyperaemia.
• Binding down tissues relieves dynamic friction.
• May insulate due to reduced heat loss by evaporation.
• Reduces high pressure areas on the foot

Against Adhesive Padding
• Prolonged wear may be unhygienic
• Offers only temporary relief
• Unable to cover open lesion
• Expensive consumable
• may macerate the local skin
• May cause irritation
• Remove natural oils
• Prescription may slip with wear
• Not suitable for sensitive skins

For Non-Adhesive Padding
• Can be removed to wash the feet
• Patient can wear prescriptions at their convenience
• Accommodates people with hyperhidrosis
• Eliminates the incidence of allergic reaction

Disadvantages of Non-Adhesive Padding
• Retaining bands may constrict tissues causing oedema
• Patient may be unable to reach their feet and remove padding
• Relies on patient care and maintenance

Here are some practical steps to follow

1. Thought
First step is to think about the type of pad you want to make.

2. Preparation
Before starting to make a pad always collect the materials you require and keep them within easy reach.

3. Cutting the Pad
Cut the pad as near as possible to the size required at the first attempt.
Cut the pad to ensure the therapeutic aim is achieved.
Always follow the contours of the foot.
Pad should cover whole area requiring protection.
*Mark edges clearly to be bevelled

4. Bevelling

Bevelling the edges of a pad is necessary to ensure a comfortable fit around bony prominence. This cuts down the amount of drag encountered when foot gear is worn. Bevelling stops the pad from forming folds at the edges which might pinch the skin. It also offers greater comfort especially with a thicker pad when the level of the pad is graduated down to a feather edge along the margins of the pad or skin level.

5. Retention
The clinician must decide whether the therapeutic outcome will improve if the pad is stuck to the skin or retained by retaining bands. In the case of patient allergy to adhesive there is no alternative. However, caution is required and the clinician requires to check there are no contraindication before making a replaceable pad.

* These optional actions are recommended for the novice.

Information for patients about mechanical therapy

Do's for Adhesive Pads
Try to wear the pad for the length of time instructed (.... weeks)
Keep the padding dry but if it should get wet then no major harm will arise.
In the event of irritation please remove padding, place foot in warm saline footbath (46 degrees C) and bathe the feet for no longer than 10 minutes. Pat the skin dry, apply antiseptic cream and lightly talcum the area. In the event of continued discomfort contact your podiatrist.
Keep the pad next to the skin but if it slips or becomes displaced then reapply and if necessary, stick it in place with plaster
Remember to dust a light talcum over the pad to prevent tackiness.

Do's for Non-Adhesive Pads
Removed padding before washing.
Apply a light talcum powder daily
In the event of prolonged discomfort remove padding.
oam In the presence of uncomfortable swelling, tightness or discomfort, remove padding.
When in use try to keep padding dry.

Common Foot Pad Prescriptions

Heel Pad

The heel pad covers the plantar surface of the calcaneum. Made from semi compressed felt to bind the skin down, or open cell foam to offer cushion by absorption. Heel pads assist in lowering shock just after heel strike, and offer short term palliation and require occlusive strapping. Chiropody Felt is an ideal vehicle to house cavities for ointments and creams.

Metatarsal Pad

The 1-5 metatarsal pad covers all five metatarsal heads, extending proximally to the bases of metatarsal shafts and distally to the metatarsal arc. Can be made in a variety of different materials. Fleecy web or extension strapping binds the skin and provides protection from dynamic friction. Semi compressed felt may protects the ball of the foot where tenderness is present. Prescription may include cavities for ointment.

2-4 Plantar Metatarsal Pad

2-4 Plantar Metatarsal pad covers the middle metatarsal heads. Prescription is indicated when mild callous is present over the first and fifth metatarsal heads and lack of fatty fibro padding appears over the other metatarsal heads. Foam or felt may be used depending on the desired outcome.

Cut out Plantar Pads

The structure of semi compressed felt is sufficient to support wings and U's to be cut into the prescriptions. This provides useful platforms to the foot where high pressure areas can be reduced by bringing contact with the ground to areas of less pressure. Commonly used prescriptions include single wings and double wings as well as U’s padding. Temporary adhesive prescriptions are translated into foot orthotic prescription, once cause and effect have been established.

Replaceable Plantar Padding

These offer an alternative to adhesive pads and can help facilitate foot hygiene as well as give the patient the option to wear or not. Not anchored to the skin, replaceable pads are easily displaced by friction and movement and a simple in-sock ( shoe inlay) may provide a better option. There is now a wide range of materials and thicknesses available to circumvent the need for replaceable pads.

Mid Foot or Filler Pad

Chiropody felt is the material of choice in mid foot prescriptions. The bulk of the material fill in the arch and increases surface contact between foot flat and heel off. This type of prescription is recommended when symptoms of arch strain are reported. Can be stuck to the skin, made replaceable, or applied to the shoe.

Dorsal Padding

Prescriptions to the dorsal surface follow the local anatomical contours.

Digital Padding

The management of digital lesions such as corns and callous are similar in principle to heel and plantar padding. Knitted dressings containing viscoelastic materials enable targeted protection. Size and shape are determined by the toe itself.

Orthodigital Therapy

Properties of moulding material such as medical grade elastomers provide a useful medium for digital orthoses. Silicone toe props passively exercise all the muscles of the leg whilst resisting compression during take off.

More Information
Kippen C 2022 Chiropody Felt: A brief history Foot Talk blog
Kippen C 2022 Physical Therapy: Introduction to foot padding and taping 101 Foot Talk blog

Reviewed 13/06/2022